Beginning with an overview of developments during the last 30 years, this article focuses on the current Cuban plan to convert the country into a family practice nation by creating a new primary care system. The new system is based on the training and placement of no less than 20,000 family physician and nurse teams by 1992. Cuba has come a long way in 30 years, as demonstrated by major health indicators.
PIP: Cuba has established a free, comprehensive, and accessible national family medicine based health care system. Since Castro came to power in 1959, the government has consistently been committed to improving living conditions, the health status of the population, and the national health system. For example, the prerevolutionary self financed health care system which served only about 20% of the population has 242 clinics and hospitals. By 1987, the health system which served the entire population had 263 hospitals and 159 social service units both of which has beds, 422 polyclinics (local health centers established in the early 1960s), 256 urban and rural medical posts, 160 dental clinics, 135 maternity homes, 22 blood banks, and 12 national research institutes. Some of the 1st macro-level actions of the Castro government entailed reducing the prices of medicine along with apportioning their importation, distribution, and production; reorganizing the national health system (MINSAP); and nationalizing all private health facilities and merging them with MINSAP. By the early 1970s, the population expressed dissatisfaction with the polyclinics, however. So, in 1974, MINSAP launched its primary care model based on addressing the interactions between the biological, social, economic, and cultural influences on community health. In spite of this change, not all of the expected improvements occurred. In the early 1980s, MINSAP created a new specialty based solely on providing primary care--the family physician and changes the medical school curriculum to incorporate family medicine. Presently a primary care team (1 family physician and nurse) cares for 600--800 individuals and lives and works in the area served. Surveys and other measures indicate that the communities are pleased with the primary care model.